General anesthesia in dentistry

The application of general anesthesia in dentistry, and especially in the context of extractive surgery of the third molar, according to the amount of clinical studies available in the Scientific Literature, to give an idea, the Scopus database, has indexed more than 800 elements of the dental field containing the term “general anesthesia” in the title.

The clinical approach to the patient should be guided by scientific evidence; in clinical practice, however, it is normal that the empirical aspect also plays a role in the decision-making process. This leads to a different regional orientation towards general anesthesia itself.

It should also be considered that any pharmacological treatment, all the more so if it is demanding in biological terms (for the patient) and in terms of human resources (if, for example, the presence of a qualified specialist is required, an anesthetist in the case in question), must be supported by an assessment of the cost/benefit ratio.

Among the variables to be considered, it is certainly necessary to consider the patient’s compensation framework with reference to the general medical history and the real needs dictated by the state of the masticatory organ, its compliance (dental treatments are often the trigger of specific phobias), and, in addition to them, the advantages deriving from one choice at the expense of another. This treatment takes an indicator of this last aspect into consideration, namely the onset of complications, asking how the transition from a regime of local anesthesia to one of general anesthesia can affect them.

General anesthesia Vs Local anesthesia

In this regard, Beteramia has recently published a study in Oral Surgery that retrospectively considered a total of 277 cases of third molar extraction included, 130 cases conducted under local anesthesia and the remaining 147 under general anesthesia, and a total of 523 teeth extracted – 239 and 284 respectively. A total of 20 complications were recorded (equal to 3.8% of the treated sites), however, unbalanced, although not significantly, in favor of local anesthesia (9 cases against 11, of which 7 infections against 1). The only significant difference is actually favorable to general anesthesia, but concerns only 5 cases of alveolar osteitis, all, however, recorded in the local anesthesia group.

In conclusion, it can be seen that, at least as far as the reduction of complications is concerned, general anesthesia in third molar surgery would seem to be easily supported as the first line of approach, even in cases of complex inclusion in non-cooperative patients. The implementation of intermediate anesthesia regimens, such as conscious sedation, or the application of techniques to minimize the anxiety and discomfort associated with conventional injection technique of local anesthesia may be recommended.

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